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Physician holding a pacemakerAn arrhythmia​​ is a disturbance in the normal rate or rhythm of your heartbeat, caused by abnormalities in the heart's electrical system. Arrhythmias can range from annoying palpitations to life threatening sudden cardiac death risks.

Some arrhythmias may require an implanted device to keep the heart beating in a healthy rhythm. These devices are implanted under the skin, typically below the shoulder, and have wires called leads that deliver electrical energy to the heart. At The Heart Hospital Baylor, we use proven medical expertise to implant the appropriate device designed to manage your arrhythmia effectively. The types of devices we implant include implantable cardiac defibrillators (ICD), cardiac resynchronization therapy (CRT) and pacemakers.

What is a Pacemaker?

A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.

Pacemakers are used to treat arrhythmias. A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting. A pacemaker also can help a person who has abnormal heart rhythms resume a more active lifestyle.

Faulty electrical signaling in the heart causes arrhythmias. Pacemakers use low-energy electrical pulses to overcome this faulty electrical signaling. Pacemakers can:

  • Speed up a slow heart rhythm
  • Help control an abnormal or fast heart rhythm
  • Make sure the ventricles contract normally if the atria are quivering instead of beating with a normal rhythm (a condition call atrial fibrillation)
  • Coordinate electrical signaling between the upper and lower chambers of the heart
  • Coordinate electrical signaling between the ventricles. Pacemakers that do this are called cardiac resynchronization therapy (CRT) devices. CRT devices are used to treat heart failure.
  • Prevent dangerous arrhythmias caused by a disorder called long QT syndrome

Pacemakers also can monitor and record your heart's electrical activity and heart rhythm. Newer pacemakers can monitor your blood temperature, breathing rate, and other factors. They also can adjust your heart rate to changes in your activity.

Pacemakers can be temporary or permanent. Permanent pacemakers are used to control long-term heart rhythm problems. Temporary pacemakers are used to treat short-term heart problems, such as a slow heartbeat that's caused by a heart attack, heart surgery, or an overdose of medicine.

Temporary pacemakers also are used during emergencies. They might be used until your doctor can implant a permanent pacemaker or until a temporary condition goes away. If you have a temporary pacemaker, you'll stay in a hospital as long as the device is in place.

How Does a Pacemaker Work?

A pacemaker consists of a battery, a computerized generator, and wires with sensors at their tips. The battery powers the generator, and both are surrounded by a thin metal box. The wires connect the generator to the heart.

A pacemaker helps monitor and control your heartbeat. The electrodes detect your heart's electrical activity and send data through the wires to the computer in the generator. If your heart rhythm is abnormal, the computer will direct the generator to send electrical pulses to your heart.

New pacemakers can monitor your blood temperature, breathing, and other factors. They also can adjust your heart rate to changes in your activity.

The pacemaker's computer also records your heart's electrical activity and heart rhythm. Your doctor will use these recordings to adjust your pacemaker so it works better for you.

Pacemakers have one to three wires that are each placed in different chambers of the heart.

  • The wires in a single-chamber pacemaker usually carry pulses from the generator to the right ventricle (the lower right chamber of your heart)
  • The wires in a dual-chamber pacemaker carry pulses from the generator to the right atrium (the upper right chamber of your heart) and the right ventricle. The pulses help coordinate the timing of these two chambers' contractions.​​
  • The wires in a biventricular pacemaker carry pulses from the generator to an atrium and both ventricles. The pulses help coordinate electrical signaling between the two ventricles. This type of pacemaker also is called a cardiac resynchronization therapy (CRT) device.

PacemakerTypes of Pacemaker Programming

The two main types of programming for pacemakers are demand pacing and rate-responsive pacing.

A demand pacemaker monitors your heart rhythm. It only sends electrical pulses to your heart if your heart is beating too slowly or if it misses a beat.

A rate-responsive pacemaker will speed up or slow down your heart rate depending on how active you are. To do this, the device monitors your sinus node rate, breathing, blood temperature, and other factors to determine your activity level.

Your doctor will work with you to decide which type of pacemaker is best for you.

What to Expect During Pacemaker Surgery

Placing a pacemaker requires minor surgery. The surgery usually is done in a hospital or special heart treatment laboratory.

Your doctor will insert a needle into a large vein, usually near the shoulder opposite your dominant hand. Your doctor will then use the needle to thread the pacemaker wires into the vein and to correctly place them in your heart.

An x-ray "movie" of the wires as they pass through your vein and into your heart will help your doctor place them. Once the wires are in place, your doctor will make a small cut into the skin of your chest or abdomen. They will slip the pacemaker's small metal box through the cut, place it just under your skin, and connect it to the wires that lead to your heart. The box contains the pacemaker's battery and generator.

Once the pacemaker is in place, your doctor will test it to make sure it works properly. The entire surgery takes a few hours.

Pacemaker Surgery Risks

Pacemaker surgery generally is safe. If problems do occur, they may include:

  • Swelling, bleeding, bruising, or infection in the area where the pacemaker was placed
  • Blood vessel or nerve damage
  • A collapsed lung
  • A bad reaction to the medicine used during the procedure​​

​Talk with your doctor about the benefits and risks of pacemaker surgery.

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services

Why The Heart Hospital Baylor?

The specialists on the medical staff of The Heart Hospital Baylor lend their experience and many years of technical expertise to your care. Our multidisciplinary program draws from a broad spectrum of specialists including cardiac surgery, interventional cardiology, cardiology, vascular surgery, interventional radiology, and a team of dedicated cardiovascular nursing specialists. This multidisciplinary team works together to provide you with the most appropriate treatment approach to your unique heart or vascular condition.

Following a pacemaker implant, The Heart Hospital stays in contact with you and your physicians. Ongoing device maintenance and management are important. With remote device follow-up, your implanted device can transmit information to a device in your home. Your home unit downloads the recorded information and sends it to our team where we can monitor how well your pacemaker is working. This allows timely checks on your device's performance.

For a physician referral, call 1.855.506.4415 (1.855.922.9567).

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